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Biomedical subjects

J Steuer

Publications and source records attributed to J Steuer.

At least 19 recordsLinked to original sources
PubMed2005

Increased risk of heart failure as a consequence of perioperative myocardial injury after coronary artery bypass grafting.

OBJECTIVE: To analyse the relation between perioperative myocardial injury (PMI) and the risk of subsequent heart failure after coronary artery bypass grafting (CABG). DESIGN AND SETTING: Clinical data were documented prospectively in all patients and stored in a computer. All hospital readmissions were identified and the registered primary diagnoses were analysed. Survival information on all patients was obtained by use of combined registers. The study was carried out at the cardiac surgical referral centre of University Hospital, Uppsala, Sweden. PATIENTS: 7493 patients discharged alive after primary CABG between 1987 and 1996 were followed up until the first hospital readmission for heart failure, death, or 31 December 1996 was reached. MAIN OUTCOME MEASURES: Hospital readmission for heart failure or late mortality. RESULTS: Of the patients studied 576 (7.7%) were readmitted for heart failure. Actuarial freedom from readmission for heart failure after four years was 93%, and after seven years, 89%. Of the 576 patients, 114 (20%) had had PMI, which increased the risk of heart failure independently (hazard ratio (HR) 2.3, 95% confidence interval (CI) 1.8 to 2.8). Increased age, female sex, diabetes, previous myocardial infarction, dyspnoea, preoperative atrial fibrillation, left ventricular dysfunction, and triple vessel disease were independent risk factors for heart failure. The use of an internal mammary artery decreased the risk. PMI implied increased mortality (HR 1.4, 95% CI 1.1 to 1.8). Late mortality was greatly increased in patients readmitted for heart failure. CONCLUSION: PMI increased the risk of heart failure and late death after CABG, and heart failure had a notable adverse effect on late survival.

Adult↗
PubMed2002

Impact of perioperative myocardial injury on early and long-term outcome after coronary artery bypass grafting.

AIMS: To establish the influence of perioperative myocardial injury on short- and long-term survival after coronary artery bypass grafting (CABG). METHODS AND RESULTS: The correlation of postoperative serum aspartate aminotransferase and creatine kinase MB to early cardiac-related death and to late survival was evaluated in 4911 patients who underwent CABG consecutively during a 6-year period. There were 93 early deaths (1.9%), 73 of them cardiac-related (1.5% of 4911). After a mean follow-up of 5 years, 409 additional deaths (8.5% of 4818) had occurred. Elevated enzyme levels on day 1 postoperatively highly increased the risk of early cardiac death (serum aspartate aminotransferase >or=2.35 microkat.l(-1): odds ratio 9.2; serum creatine kinase MB >or=61 microg.l(-1): odds ratio 6.0), and increased the risk of late death by approximately 50% (serum aspartate aminotransferase >or=2.35 microkat.l(-1): relative hazard 1.5; serum creatine kinase MB >or=61 microg.l(-1): relative hazard 1.4). This increased risk of death was independent of other risk factors and remained constant over time. CONCLUSIONS: Enzyme elevation after CABG implied an increased risk of both early and late death. The long-term effect persisted many years after surgery.

Aged↗
PubMed1998

[Neurological complications after open heart surgery. Risk factors identified in a retrospective study].

Cerebral complications were documented in 2 per cent (133/6666) of open heart procedures performed in adults at the Karolinska hospital, during the 7-year period, 1990-96. In 32 per cent (42/133) of cases, the neurological symptoms appeared after an uneventful postoperative interval of 2-14 (median 3) days. These patients were older and were characterised by a tendency toward a greater prevalence of carotid artery disease and of postoperative atrial arrhythmia. By contrast, the subgroup whose cerebral symptoms occurred immediately after the operation was characterised by greater severity of the symptoms, long operation time, and poor preoperative left ventricular function. Aggressive postoperative anticoagulant treatment, especially in patients with supraventricular arrhythmias, would seem to be justified to reduce the risk of neurological complications.

Adult↗
PubMed1995

The use of combination internal fixation and hybrid external fixation in severe proximal tibia fractures.

Forty-eight patients with 50 severe fractures of the proximal tibia were followed prospectively for 2-4 years (mean 2.7 years) to evaluate the use of limited internal fixation combined with external fixation in the treatment of these injuries. There were 27 men and 21 women ranging in age from 20 to 74 years. Fractures were classified according to the A0 system (Mast J, Ganz R, Jacob R: Planning and reduction technique in fracture surgery. Berlin, Springer-Verlag, 1989), which included 5 A3, 6 C1, 16 C2, and 23 C3 fractures. All patients in this series healed; 48 fractures healed in an average of 12 weeks without subsequent surgery. There were two (4%) nonunions requiring bone graft. The average hospital special surgery knee score was 90 (68-100). Grading criteria for anatomical outcome revealed there were 17 (34%) excellent results, 24 (48%) good results, 6 (12%) fair results, and 3 (6%) poor results. In conclusion, this treatment method is associated with a high percentage of good and excellent results. Combined internal and external fixation combines the advantages of anatomic, stable fixation with less soft-tissue dissection and eliminates the need for large implants.

Adult↗
PubMed1994

Treatment of grade-IIIb open tibial fractures. A prospective randomised comparison of external fixation and non-reamed locked nailing.

Severe open fractures of the tibia have a high incidence of complications and a poor outcome. The most usual method of stabilisation is by external fixation, but the advent of small diameter locking intramedullary nails has introduced a new option. We report the early results of a randomised, prospective study comparing external fixation with non-reamed locked nails in grade-IIIb open tibial fractures. Of 29 patients, 15 were treated by nails and 14 by external fixation. Both groups had the same initial management, soft-tissue procedures, and early bone grafting. All 29 fractures healed within nine months, but the nailed group had slightly better motion and less final angulation. Complications included one deep infection and two pin-track infections in the external fixator group and one deep infection and one vascular problem in the nailed group. Although the differences in healing and range of motion were not statistically significant, we found that the nailed fractures were consistently easier to manage, especially in terms of soft-tissue procedures and bone grafting. It is the treatment preferred by patients and does not require the same high level of patient compliance as external fixation. The only factors against nailing are the longer operating time and the greater need for fluoroscopy. We consider that locked non-reamed nailing is the treatment of choice for grade-IIIb open tibial fractures.

Adult↗
PubMed1993

Pilon fractures: treatment with combined internal and external fixation.

The purpose of this study was to prospectively evaluate the use of limited internal fixation and the application of a hybrid external fixator (tensioned wires distally and 5.0 mm half pins proximally attached to a semicircular frame without crossing the ankle joint) in the treatment of severe distal tibia fractures. This technique involves accurate reduction and fixation of the intraarticular component through an incision based over a fracture site followed by stabilization of the metaphysis with the hybrid external fixator. We studied 26 patients 15-55 years of age who were followed for 8-36 months. All fractures were within 5 cm of the joint. Seventeen fractures were intraarticular, nine extraarticular, and six open. Eleven patients required bone grafting. The average time to healing was 4.2 months. Using clinically based criteria, there were 81% good and excellent results overall, 70.5% for the 17 intraarticular fractures, and 69% for Ruedi type III fractures. Complications included one superficial and one deep infection, one 10 degrees varus malunion, and three pin tract infections. This method yielded results comparable with previous studies while reducing the amount of soft tissue dissection necessary for the placement of large plates. Soft tissue complications were infrequent and the goals of early motion and fracture stability were not sacrificed.

Adolescent↗
PubMed1990

[Basic and advanced training in radiation protection in stomatology].

Considering the importance of radiation protection in dental radiology and the respective legal regulations of the GDR, objectives and contents of basic and advanced training of responsible co-workers in radiation protection are described. Particular organisational aspects regarding training courses in the National Board for Atomic Safety and Radiation Protection are outlined.

Humans↗
PubMed1982

Treating geriatric depression: a 26-week interim analysis.

Two concurrent studies of geriatric outpatients who received diagnoses of depression were conducted. In the first, patients were treated with one of two tricyclic antidepressants or with a placebo. In the second, patients were assigned to groups receiving either psychodynamic group therapy or cognitive-behavioral group therapy. Patients in the placebo group showed the least improvement; most patients receiving group psychotherapy showed some improvement, but only 12% had full remissions; by contrast, 45% of patients receiving imipramine or doxepin had full remissions, while 36% of them experienced little or no benefit. An early response to tricyclic antidepressant drugs was a reliable predictor of continued improvement.

Antidepressive Agents, Tricyclic↗
PubMed1981

"Critical loss" in the eighth and ninth decades.

Data from the last survivors of the New York State Psychiatric Institute Twin study were examined to determine if the previously identified relationship between "critical loss" and 5-year survivorship still held true for persons in their eighth and ninth decades of life. Twenty-two subjects (age range 83 to 99 years) were tested in 1973 and by 1978, 12 had died, making it possible to retrospectively examine the relationship between survivorship and critical loss. "Critical loss" did not distinguish survivors from decedents, but presence or absence of OBS did distinguish the groups, with seven of eleven decedents and none of eight survivors being so diagnosed. Survivors did not differ significantly from non-survivors in annual rate of decline on any of the three "critical loss" tests (Vocabulary, Similarities, Digit Symbol Substitution), though survivors had higher mean scores on all three tests.

Aged↗